This handout is for peritonsillar abscess (quinsy). Your care team identified this based on: severe unilateral sore throat with trismus, dysphagia, and odynophagia worsening over 2-5 days (classic peritonsillar abscess presentation — klug dan med j 2017; kim acad emerg med 2023).
Other reasons your team may use this plan: "hot-potato"/muffled voice with uvular deviation, soft-palate fullness, and contralateral tonsillar displacement (cardinal abscess sign — chang cochrane 2016); drooling / pooled secretions with trismus and inability to tolerate oral secretions — airway + dehydration entry (klug dan med j 2017); ≥1 prior peritonsillar abscess or recurrent tonsillitis — recurrence / quinsy-tonsillectomy entry (aao-hns tonsillectomy 2019 — >1 pta is a tonsillectomy modifying factor).
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| needle_aspiration | — | — | — | Chang Cochrane 2016 (PMID 28009937) — needle aspiration is less painful than I&D; very-low-quality evidence suggests higher recurrence (RR 3.74, 95% CI 1.63-8.59 favouring I&D); often POCUS-guided (Todsen Diagnostics 2018, PMID 30072648) |
| incision_and_drainage | — | — | — | Chang Cochrane 2016 (PMID 28009937) — I&D associated with lower recurrence than aspiration (RR 3.74); Mansour Eur Arch Otorhinolaryngol 2019 (PMID 31300842) — shorter LOS + fewer repeat procedures vs aspiration; post-I&D bleeding ~3.6% |
| quinsy_acute_tonsillectomy | — | — | — | Rosi-Schumacher Int J Pediatr Otorhinolaryngol 2023 (PMID 37352593) — quinsy tonsillectomy and I&D have equivalent outcomes; Gawel Int Arch Otorhinolaryngol 2025 (PMID 41113746) — quinsy tonsillectomy safe (no excess haemorrhage) despite higher comorbidity |
Plan: Peritonsillar abscess — drainage ladder + anaerobe/GAS antimicrobial + adjunct steroid
Call 911 or go to the nearest emergency room right away if you have:
Smoking-cessation counselling (smoking is an independent PTA risk factor — Klug Dan Med J 2017); ENT follow-up; recurrence counselling. Interval/quinsy tonsillectomy candidacy if ≥1 prior PTA or recurrent tonsillitis meeting AAO-HNS modifying-factor criteria (AAO-HNS Tonsillectomy 2019; Rosi-Schumacher 2023 — quinsy and interval tonsillectomy equivalent outcomes). Counsel return precautions for re-accumulation, airway, and Lemierre.
Guideline: Cochrane needle-aspiration-vs-incision-and-drainage review (Chang et al, Cochrane Database Syst Rev 2016) + Kim et al ultrasound diagnostic-accuracy systematic review/meta-analysis (Acad Emerg Med 2023) + Hur et al adjunct-corticosteroid systematic review (Laryngoscope 2018) + AAO-HNS Clinical Practice Guideline: Tonsillectomy in Children — Update (Mitchell et al, 2019) + Klug Fusobacterium-microbiology body of work (Dan Med J 2017) + Wright/Tiwari Lemierre literature